Super bone graft to help arthritis sufferers back on their feet

For six years Brian Girdwood struggled with chronic and worsening neck and shoulder pain.

Then two years ago scans showed he was developing arthritis — or wear and tear on the joints.

‘Years of boxing, rugby and marathons in the Army were taking their toll,’ says Brian, a crane driver from Brynamman, Carmarthenshire.

Usually a graft involves taking a small amount of bone - sometimes the size of sugar cube or bigger - from elsewhere in the body

‘I’d go back to the GP for painkillers, but even with these sometimes I was in agony and had disturbed sleep for weeks,’ says Brian.

‘I need to turn my head constantly at work, but any little movement in my neck hurt so I’d have to move my whole body to look up.’

After various treatments failed to provide relief, Brian was offered surgery to remove the disc and a bone graft to fuse the bones in his neck together to stop them grinding against each other.

Every year at least 26,000 Britons have a bone graft, either to repair a fracture or to fuse bones to prevent pain.

Fusion is often used to tackle wear and tear in the spine and ankles, or for deformities such as hammer toes.

Often the bone graft used comes from donated bone pooled from overseas (though mainly from the U.S.).

This has been controversial in recent years — many readers will recall the shocking revelation that the veteran BBC radio presenter Alistair Cooke’s bones were stolen after he died in the U.S. from cancer (which had spread to his bones); his bones were thought to have been taken for use in surgery.

Share this article

But Brian was one of the first British patients to benefit from new, ‘super’ bone grafts sourced in the UK.

Bone graft is basically powdered bone that is made up into a form of putty.

This acts like a scaffold — because the bone also contains proteins that act as powerful growth factors, it induces new bone to form.

The old bone fuses with the new, providing a strong bond.

Usually a graft involves taking a small amount of bone — sometimes the size of sugar cube or bigger — from elsewhere in the body.

Typically this is from the pelvis but it can be a painful procedure, with a nine per cent risk of chronic pain afterwards at the bone harvest site.

So surgeons tend to use donor bone graft material, which is often pooled from sources abroad.

The worry is that this makes it difficult to track down the source if there’s ever a problem.

There have also been concerns about reports of the criminal procurement of human tissues, such as in the case of Alistair Cooke.

Although NHS Blood and Transplant (NHSBT) has been able to provide UK-sourced bone graft material, it has not been able to provide the ‘super’ version — known as demineralised bone.

This is bone that has been treated to remove the minerals — which in turn exposes the stimulating proteins in the bone, so the graft is even better at encouraging new bone. Hitherto this demineralised bone came from overseas.

But thanks to a major investment, NHSBT has the equipment to produce it in the UK.

First the bone is extensively washed and the mineral is removed to expose the stimulating proteins.

There have been concerns about reports of the criminal procurement of human tissues

Then the final product is irradiated to ensure the graft is sterile.

Because the organisation is also in control of the whole process from donor selection and consent, to tissue retrieval, processing and storage to distribution, the system is much more efficient — and safer for patients, say experts.

Last November, Brian underwent a bone graft using NHS demineralised bone from a carefully screened single donor.

He had previously had surgery to remove bony spurs (bits of bone that the body creates to try to repair damage) which were growing into his shoulder tissue, causing pain and inflammation.

However, although this has helped, ‘turning my head was still agony at times’, recalls Brian.

By autumn last year, the pain was unbearable so his GP sent Brian for more scans.

These showed he now had bony growths on the vertebrae in his neck — furthermore, one of the discs that cushion the vertebrae had ruptured, and was beginning to press on the nerves, exacerbating the pain.

He had the one-hour neck fusion operation at the Morriston Hospital in Swansea, the first UK hospital to use NHS-sourced donor bone.

After the consultant spinal surgeon Iona Collins removed the ruptured disc, she filled the gap between the vertebrae with a plastic cage filled with the bone graft material, to form a strong bony column.

‘Most importantly, we know exactly where each vial has come from, since it comes from one UK donor alone.’

There are three different ways the donor bone is given — it can come via the donor organ register; living donors can also give consent for the top of the thigh bone, which is removed during a hip replacement, to be donated, or families can donate after their loved one’s death.

Potential UK donors are screened and tested for infectious diseases — less than ten per cent of potential donors meet the criteria for donation.

‘Demineralised bone matrix is widely used in spinal surgery,’ explains Masood Shafafy, a consultant spinal surgeon at the Queen’s Medical Centre in Nottingham and spokesman for the British Orthopaedic Association.

‘However, like blood transfusion, it is obtained by donation — the new screening and processing by NHSBT is top notch, and instead of material coming from multiple donors in the States it comes from a single UK donor, who could be traced in case of a problem.’

Using UK-sourced donor grafts is also more cost effective.

‘By switching suppliers from a profit-making private company to an NHS non-profit source, it also means we are able to make financial savings,’ says Miss Collins.

Savings vary, but can be ten to 20 per cent per graft.

Miss Collin adds: ‘And the implications for orthopaedic surgery from such savings are huge, since this could be used for a huge range of procedures.’

For Brian, however, the benefits are much more immediate. The bones in his neck have now fused, so he can move his head without fear of pain.

‘Now all the pain has gone, and I feel fantastic. I’m on cloud nine,’ he says.

‘This operation has changed my life, and I’m back at work without any pain: when I had a virus in February, the only joint that didn’t hurt was my neck.